The risk of end-stage renal disease in systemic lupus erythematosus: A nationwide population-based study in Korea

Abstract

Systemic lupus erythematosus (SLE) is known to be one of the leading causes of end-stage renal disease (ESRD). The aim of this study was to estimate the incidence rate of ESRD and the risk for progression to ESRD in SLE patients compared to the general population.A total of 21,253 SLE patients were extracted from the Korean National Health Insurance Service database between 2008 and 2013. Age-and sex-matched controls (n = 106,265) were randomly sampled in a 5:1 ratio from non-SLE individuals. Both cohorts were followed up for development of ESRD until 2015.During the median 7.53 years of follow-up, 533 (2.51%) cases of ESRD were newly developed in SLE patients and 145 (0.14%) cases in matched controls (incidence rate: 4.075 and 0.219 per 1000 person-year, respectively). SLE patients were at higher risk for ESRD development compared to matched controls (hazard ratio [HR], 9.84; 95% confidence interval [CI] 8.10-11.96) after multivariate adjustment. In subgroup analysis, the risk for ESRD was higher in male (HR, 7.76; 95% CI 5.07-11.90) and female patients with SLE (HR, 10.48; 95% CI 8.41-13.07) than in matched controls. When analyzed by age group, the younger the age, the higher the risk of ESRD versus non-SLE matched controls; this result was also significant after adjustment. In subgroup analysis according to comorbidities, the SLE group had a significantly higher risk of ESRD than the non-SLE group in almost all subgroups.SLE was associated with an increased incidence of ESRD.

Figure 1

Kaplan–Meier curve for 8-year crude cumulative incidence of ESRD between SLE and non-SLE patients. (P of log-rank <.001). ESRD = end-stage renal disease, SLE = systemic lupus nephritis.

Figure 2

Analysis of end-stage renal disease in subgroups of patients with SLE. HRs and 95% CIs of end-stage renal disease in the SLE group vs control in subgroups. Adjusted for age, sex, income, diabetes mellitus, hypertension, dyslipidemia, myocardial infarction, stroke, congestive heart failure, and CKD. CI = confidence interval, CKD = chronic kidney disease, HR = hazard ratios.